Prevalence and factors associated with depression among pregnant mothers in the West Shoa zone, Ethiopia: a community-based cross-sectional study

The epidemiology of maternal mental health in Africa: a systematic review

BACKGROUND

Despite a growing body of evidence on maternal mental health in Africa, significant gaps remain in understanding its overall landscape, risk factors/determinants, immediate and long-term effects, accessibility to healthcare and services, and availability of practicable/effective interventions. This paper provides a thorough review of both peer-reviewed and grey literature and makes key recommendations and directions for future research and development.

METHODS

We systematically reviewed extant evidence using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Peer-reviewed studies published in English between 2010, and June 2024 were included based on a priori criteria. The National Institutes of Health (NIH) and Critical Appraisal Skill Program (CASP) quality assessment tools were used to critically appraise the reliability, validity and overall quality of included articles. A qualitative narrative synthesis was perfomed to summarize the findings effectively.

RESULTS

A total of 206 full-text articles evaluated for eligibility and inclusion in the systematic review, predominantly observational studies with a minority employing randomized controlled trial (RCT) designs, were included, with 70%, 22%, and 8% of the articles rated as good, fair, and poor quality, respectively. Women in Africa experience a wide range of common perinatal mental disorders, including major depressive disorders and psychosis, either discretely or comorbid. Socioeconomic disadvantages and other intertwined poverty-related factors at the individual, family, social, and environmental levels are implicated in maternal mental health disorders. Currently, there is insufficient evidence regarding the short- and long-term health, development, and social impacts of maternal mental health. Addtionally, there is limited knowledge about the availability and accessibility of mental healthcare, evidence-based context-specific interventions, and healthcare-seeking behaviors of women in Africa, as well as their access to and utilization of mental health services.

CONCLUSION

The evidence base on maternal mental health in Africa suffers from considerable variability, inconsistency, and equivocal findings resulting from heterogeneity across the studies. This restricts generalizability and the ability to draw valid conclusions. Published studies also likely underestimate the scale and health impacts of perinatal mental disorders. Evidence from these studies are rarely used to inform policies and programs. The maternal mental health ecosystem in Africa needs to be better understood. More rigorous study designs should be implemented to focus on evidence generation and the evaluation of interventions, alongside robust integration of mental health services within health systems. Policy initiatives aimed at reducing socioeconomic disparities in maternal, newborn, and child health, particularly concerning maternal mental health, must be supported by these studies.

ARTICLE HIGHLIGHTS

• Women across Africa suffer from various mental health problems, including major depressive disorders, anxiety, and psychosis, occurring separately or in combination. • The evidence base on maternal mental health in Africa displays significant variability, inconsistency, and ambiguous findings, largely attributed to study heterogeneity. • Factors at the individual, familial, societal, and environmental levels contribute to poverty-related issues that can lead to or worsen maternal mental health disorders. • Current evidence has not been synthesized to improve our understanding of the short- and long-term health impacts, developmental consequences, and social implications of maternal mental health conditions, as well as the healthcare-seeking behaviors and access to mental health services. • Insufficient policy prioritization and funding for maternal mental health in Africa hinder the development, evaluation, and sustainability of interventions. • There is an urgent need to integrate mental health services into primary healthcare, particularly in resource-limited settings across Africa. This integration should be guided by evidence from rigorous research that uses longitudinal designs. It is also essential to emphasize the importance of investing in digital and community-based approaches to improve the accessibility to mental health services.

Perinatal depression and associated factors in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Perinatal depression is a significant public health issue affecting one in four women globally. It occurs at a critical time of a woman's life; affecting her relationships with family, and child's emotional, behavioral, and cognitive development. Considering the burden of the problem to the whole family, this systematic review and meta-analysis was conducted to estimate the pooled prevalence of perinatal depression and its determinants in Ethiopia to provide up-to-date evidence at a national level.

METHODS

All observational studies conducted on perinatal depression in Ethiopia were included based on the selection criteria. Data was extracted using Microsoft Excel and then exported to STATA version-11 for analysis. The random-effects model was employed to estimate the pooled effect size of perinatal depression and its determinants with 95% confidence intervals. Funnel plots analysis and Egger regression tests were conducted to check the publication bias. Sub-group and sensitivity analyses were also performed.

RESULTS

This systematic review and meta-analysis included thirty studies and the pooled prevalence of perinatal depression in Ethiopia was 24.29% (95% CI (21.98, 26.59)). According to the subgroup analysis, the pooled prevalence of antenatal depression and others (postnatal and perinatal depression) was 24.24% and 24.52% respectively. Regarding determinants of perinatal depression, having unplanned pregnancy [OR = 3.04 (2.2, 4.2)], intimate partner violence [OR = 3.09(2.14, 4.46)], poor social support [OR = 3.3(2.38, 4.57)], and a history of depression [OR = 3.68(2.45, 5.52)] were significantly associated with depression.

CONCLUSION AND RECOMMENDATION

This study showed that the pooled prevalence of perinatal depression in Ethiopia was found to be high. To ensure the mental health of both the mother and child, health professionals should routinely screen perinatal women for depression giving special focus for those with a history of depression and managing them accordingly.

A comparative study of antenatal depression among urban and rural pregnant women in Gimbi District, Oromia, Ethiopia

Background

Antenatal depression (AND) is a form of clinical depression that can be caused by stress and worries that can bring pregnancy to more severe levels. It has negative impacts on women, the family, and the community at large. The comparative study of antenatal depression among rural and urban pregnant women was less studied in Ethiopia and in this study area in particular.

Objective

The objective of the study was to compare the prevalence of antenatal depression and its associated factors among pregnant women in Gimbi rural and urban residents in Ethiopia in 2023.

Methods

A community-based comparative cross-sectional study design was used from 1 February to 30 March 2023. A systematic random sampling method was used to select study participants. Data were collected using pretested interviewer-administered structured questionnaires. Binary logistic regression analysis was used to identify factors associated with antenatal depression. Variables with a p-value of 0.25 or less in the bi-variable logistic regression model were candidates for a multi-variable logistic regression model.

Results

The prevalence of antenatal depression was 56 (21.5%), 95% CI: [16.9-25.5] among rural participants and 50 (19.2%) [95%] CI: [14.6-23.8] among urban participants. Having complications during pregnancy (AOR: 4.92, 95% CI: 1.35, 17.88), ever had depression (AOR: 3.20, 95% CI: 1.30, 7.85), consuming alcohol (AOR: 3.78, 95% CI: 1.24, 11.49), and educational status (can read and write) (AOR: 2.14, 95% CI:1.05, 4.67) were factors associated with antenatal depression among urban mothers, while no antenatal care follow-up (AOR: 6.6, 95% CI: 2.63, 16.85), unplanned pregnancy (AOR: 4.51, 95% CI:1.10, 1.86), and having complications during pregnancy (AOR: 2.77, 95% CI: 1.30, 5.92) were factors associated with antenatal depression among rural mothers.

Conclusion

The prevalence of antenatal depression among rural mothers was higher than the prevalence of antenatal depression among urban mothers in the Gimbi district. Having complications during pregnancy, ever had depression, consuming alcohol, and educational status were associated factors with antenatal depression among urban mothers; having complications during pregnancy, unplanned pregnancy, and no ANC follow-up were factors associated with antenatal depression among rural mothers. Therefore, quality family planning and ANC services should be provided for the women to reduce unplanned pregnancies and experience complication-free pregnancy periods.

Prenatal depression among pregnant women attending public health facilities in Babile district, Eastern Ethiopia: a cross-sectional study

BACKGROUND

Depression during pregnancy is a significant health concern that can lead to a variety of short and long-term complications for mothers. Unfortunately, there is a lack of information available on the prevalence and predictors of prenatal depression in rural eastern Ethiopia. This study assessed prenatal depression and associated factors among pregnant women attending public health facilities in the Babile district, Eastern Ethiopia.

METHOD

An institution-based cross-sectional study was conducted among 329 pregnant women attending Babile District Public Health Facilities from November 1 to December 30, 2021. Bivariable and multivariable logistic regression were used to identify factors associated with prenatal depression. The adjusted odds ratio (AOR) with a 95% confidence interval was used to report the association, and the significance was declared at a p-value < 0.05.

RESULTS

The prevalence of prenatal depression was 33.1% (95% CI = 28.0%, 38.2%). A lower income (AOR = 3.85, 95% CI = 2.08, 7.13), contraceptive use (AOR = 0.53, 95% CI = 0.28, 0.98), unintended pregnancy (AOR = 2.24, 95% CI = 1.27, 3.98), history of depression (AOR = 5.09, 95% CI = 2.77, 9.35), poor social support (AOR = 5.08, 95% CI = 2.15, 11.99), and dissatisfied marriage (AOR = 2.37, 95% CI = 1.30, 4.33) were the factors associated with increased prenatal depression among pregnant women.

CONCLUSIONS

One in every three pregnant women in rural eastern Ethiopia had prenatal depression. Monthly income, contraceptive use, pregnancy intention, history of depression, social support, and marriage satisfaction status were the determinants of prenatal depression. Preventing unintended pregnancies by encouraging women to utilize modern contraceptive methods is essential for mitigating and controlling the risks and burdens of prenatal depression and its negative consequences.

Factors associated with antenatal depression among women attending antenatal care at Mubende Regional Referral Hospital: a cross-sectional study

INTRODUCTION

This study aimed to investigate the prevalence, severity, and factors associated with antenatal depression among women receiving antenatal care at Mubende Regional Referral Hospital (MRRH) in Uganda. Antenatal depression is a critical concern for maternal and child well-being, as it is associated with adverse outcomes such as preterm birth, abortion, low birth weight, and impaired maternal-infant bonding. Despite several international guidelines recommending routine screening for antenatal depression, local Ugandan guidelines often overlook this essential aspect of maternal care.

METHODS

A cross-sectional study involving 353 pregnant women utilized the Patient Health Questionnaire 9 (PHQ-9) to assess antenatal depression. Participants were categorized as having antenatal depression if their total PHQ-9 score was ≥ 5 and met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for either major or minor depression. Psychosocial demographic and obstetric characteristics were recorded. Logistic regression analysis identified factors linked to antenatal depression.

RESULTS

The burden of antenatal depression was notably high, affecting 37.68% of the participants. Among those with antenatal depression, the majority exhibited mild symptoms 94 (70.68%). The significant factors associated with antenatal depression, revealed by multivariate analysis, included younger age (≤ 20 years), older age (≥ 35 years), history of domestic violence, alcohol use, gestational age, history of abortion, history of preeclampsia, and unplanned pregnancies.

CONCLUSION

This study revealed a significantly high prevalence of antenatal depression, emphasizing its public health importance. Most cases were classified as mild, emphasizing the importance of timely interventions to prevent escalation. The identified risk factors included age, history of domestic violence, alcohol use, first-trimester pregnancy, abortion history, previous preeclampsia, and unplanned pregnancy.

Antenatal depression and associated factors among pregnant women attending antenatal care at public health facilities in the Gida Ayana district, Oromia Region, West Ethiopia, in 2022

Background

Though antenatal depression (AND) has a risk of maternal and fetal morbidity and mortality, it is a neglected component of pregnancy care in Ethiopia. Research evidence is compulsory in different parts of the country to alleviate this problem. Thus, this study was needed to assess antenatal depression and its associated factors, which can help antenatal care (ANC) providers and program coordinators focus on the mental health of pregnant mothers.

Objectives

This study aimed to assess antenatal depression and associated factors among pregnant women attending ANC at public health facilities in the Gida Ayana district, Oromia Region, West Ethiopia, in 2022.

Methods

A facility-based cross-sectional study was conducted among 370 pregnant women attending ANC at public health facilities. Systematic random sampling techniques were used to select study participants. A standard (validated) tool, the Edinburgh Postnatal Depression Scale, was also used to assess antenatal depression. The collected data were coded, entered into Epi-data software version 4.6, and analyzed by SPSS version 23. Multivariable logistic regression analyses were used to identify associated factors with a p-value <0.05.

Results

In this study, the prevalence of antenatal depression was 62 (16.8%; 95% CI: 13, 20.5). Being single in marital status (AOR = 3, 95% CI: 1.5, 6.2), having an unplanned pregnancy (AOR = 2.7, 95% CI: 1.45, 5.1), and having partner conflict (AOR = 3.49, 95% CI: 1.79, 6.8) were the factors associated with antenatal depression.

Conclusion

About one in five pregnant women has antenatal depression. Being single, having an unplanned pregnancy, and having a dissatisfied relationship with a sexual partner were the factors associated with antenatal depression. Therefore, women or partners are expected to plan pregnancy, and the dissemination of health information related to an unplanned pregnancy needs to be intensified by health providers. The partner ought to avoid conflict during the pregnancy, and healthcare providers or families are needed to support the single or widowed pregnant women. Further prospective cohort studies are needed to ascertain the effect of antenatal depression on fetal-maternal outcomes.

Effects of the Covid-19 Pandemic on the Prevalence of Insomnia, Anxiety, and Depression During Pregnancy: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis study aims to determine the effects of the Covid-19 pandemic on the prevalence of insomnia, anxiety, and depression symptoms during pregnancy. Reviews were done through PubMed, EBSCO (Medline, CINAHL), Embase (OVID), Web of Science, PsycINFO, TR Index, Turkish Thesis Center databases using (pregnancy OR pregnant) and (sleep OR sleep disorders OR insomnia), and (anxiety OR depression) keywords between April and May 2021. The meta-analysis included 48 articles (sample: 77,299). It was found that the Covid-19 pandemic did not affect the prevalence of depression symptoms and anxiety during pregnancy, but it increased insomnia. While insomnia ratio was reported 39.6% (95% CI: 0.253-0.560) in the studies conducted before the pandemic, it was reported 88.8% (95% CI: 0.821-0.921) in the studies conducted during the pandemic. This study found that the Covid-19 pandemic did not have effects on depression symptoms and anxiety, but it increased insomnia complaints.

Depression remains a neglected public health problem among pregnant women in Northwest Ethiopia

BACKGROUND

Antenatal depression is highly prevalent but a neglected public health problem in low income countries. It has serious effects on the general health of women, birth outcomes and child health. However, there has been limited substantial evidence on the prevalence and predictors of antenatal depression in Ethiopia. This lack of evidence potentiates the consequences of the problem and can limit the attention to intervention. Thus, this study aimed to assess the prevalence and potential predictors of antenatal depression at Debre Tabor and Woreta towns, Northeast Ethiopia.

METHODS

A community-based cross-sectional study was employed on 548 pregnant women recruited by a cluster sampling method. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). The List of Threatening Experiences Questionnaire (LTE-Q), the Oslo-3 Social Support Scale (OSSS-3), Intimate Partner Violence (IPV) Scale and Fast Alcohol Screening Test (FAST) were also used to measure stressful events, social support, intimate partner violence (IPV) and hazardous alcohol use respectively. Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with antenatal depression.

RESULTS

The prevalence of antenatal depression was found to be 24.45% (95% CI: 21.20, 28.30%). Being single (AOR =3.32, 95% CI = 1.36, 8.09); fear of pregnancy complication (AOR = 3.84, 95% CI = 1.53,9.62); history of chronic illness (AOR = 8.14, 95% CI = 2.14, 30.91); unplanned pregnancy (AOR = 2.99, 95% CI = 1.36,6.55); history of stillbirth (AOR = 3.56, 95% CI = 1.23, 10.29),one or more negative life events (AOR = 4.06, 95% CI = 1.71, 9.66) and intimate partner violence (AOR = 3.91, 95% CI = 1.65, 9.26) were factors significantly associated with antenatal depression.

CONCLUSION

Nearly a quarter of pregnant women suffer from depressive symptoms during pregnancy. Being single; fear of pregnancy complication; history of chronic illness; unplanned pregnancy; history of stillbirth; one or more negative life events and intimate partner violence were important predictors of antenatal depression in this study. Health care workers should consider addressing these risk factors during a routine antenatal care. Also, integrating early screening, detection, and treatment of antenatal depression into routine antenatal care is warranted to improve the quality of life of pregnant women and pregnancy outcomes as well.

The effect of cognitive-behavioral counseling of pregnant women with the presence of a spouse on stress, anxiety, and postpartum depression

BACKGROUND

Pregnant women are classified as one of the vulnerable groups. Physiological and psychological changes during pregnancy predispose them to serious psychiatric disorders; if not identified and treated in time, it can have a negative and long-term impact on mental health. The aim of this study was to determine the effect of cognitive-behavioral counseling of pregnant women with the presence of a spouse on the level of stress, anxiety, and postpartum depression.

MATERIALS AND METHODS

The present study is a clinical trial that was performed on 40 pregnant women with a gestational age of 32-28 weeks (20 in the intervention group, 20 in the control group) who were randomly assigned to the intervention group and the control group according to the inclusion criteria. Cognitive-behavioral group counseling in the presence of spouses was performed by the midwife and under the supervision of a psychologist, in eight sessions, each session lasting 90 min, once a week for the intervention group. The control group received routine care and a counseling session. Data collection tools were demographic information questionnaire and Depression-Anxiety-Stress Scale 21, which were completed before the intervention, immediately after the intervention, and on the 14^th day after delivery in both groups. Data analysis was performed using statistical tests, independent t-test, repeated measures test, Bonferroni post hoc test, and Kolmogorov-Smirnov test.

RESULTS

The results of this study showed that the mean scores of stress, anxiety, and depression in the two groups in the preintervention stage were not significantly different (P < 0.05), but in the postintervention stage and follow-up, the mean scores of stress (P < 0.001), depression (P = 0.010), and anxiety (P = 0.029) in the intervention group were significantly reduced compared to the control group.

CONCLUSION

According to the research findings, cognitive-behavioral group counseling can be effective as an approach in improving the symptoms of stress, anxiety, and depression in pregnant women. Therefore, it is necessary to plan properly to use this counseling approach to manage stress, anxiety, and depression in women during pregnancy.

Prevalence of Depressive Symptoms Among Pregnant and Postpartum Women in China During the COVID-19 Pandemic

OBJECTIVE

According to recent studies, the COVID-19 pandemic has been associated with an increased risk of mental health problems across many subpopulations including pregnant and postnatal women. This study examined the prevalence and correlates of depressive symptoms (depression hereafter) in Chinese pregnant and postpartum women during the COVID-19 pandemic.

METHODS

This was a multicenter, cross-sectional study comprising 1309 pregnant and postpartum women across 12 provinces in China during the COVID-19 pandemic. Depression was assessed using the nine-item Patient Health Questionnaire. Univariate analyses and multivariate logistic regression analyses were conducted.

RESULTS

The prevalence of depression in pregnant and postpartum women was 27.43% (95% confidence interval [CI] = 25.01%-29.85%). Women who were worried about themselves or their babies being infected with COVID-19 (odds ratio [OR] = 2.562, 95% CI = 1.670-3.929), and those who had delayed regular medical checkups (OR = 2.434, 95% CI = 1.580-3.750) were at higher risk of depression. Compared with those living in central and western parts of China, women living in northern (OR = 0.513, 95% CI = 0.326-0.807) and southeastern parts of China (OR = 0.626, 95% CI = 0.463-0.846) were less likely to have depression.

CONCLUSIONS

The COVID-19 pandemic was associated with an increased likelihood of mental health problems among pregnant and postnatal women. Over a quarter of the pregnant and postpartum women in China had depression during the COVID-19 pandemic. Considering the negative health impact of depression, preventive measures, regular mental health screening, and medical checkups are needed with the goal to reduce the risk of depression in this vulnerable population during a pandemic.